Health Insurance Satisfaction Survey Form
Your Name (optional)
Name of Insurance Provider
*
Overall, how satisfied are you with your insurance provider?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Why did you give the answer above?
*
Select
Cost
Customer Service
Speed of Payment
Type of Coverage Offered
Website
Overall, how satisfied are you with your Insurance plan?
*
Very Satisfied
Somewhat Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Why did you give the answer above?
*
Select
Approval Requirements
Approval Speed
Coverage
Out-of-Pocket Costs
Size of Provider Network
Variety of Plans Offered
How affordable is your health insurance plan?
*
Very Affordable
Somewhat Affordable
Not Very Affordable
Too Expensive
What do you like most about your insurance plan?
*
What do you like least about your insurance plan?
*
Would you recommend this insurance provider to family/friends?
*
Yes
No
What is the main reason for your answer?
*
May we contact you for further feedback on your opinions?
*
Yes
No